Michalle Soudack

Diagnosing Carotid Stenosis by Doppler Sonography State of the Art

The goal of this review article is to present the state of the art in the clinical applications and technical performance and interpretation of carotid sonographic examinations.

Spontaneous Thrombosis of Hepatic Posttraumatic Pseudoaneurysms Sonographic and Computed Tomographic Features

Hepatic artery pseudoaneurysms are rare complications of blunt abdominal trauma. In the past, surgical ligation was the recommended treatment; today, it is embolization. We report a case of a child involved in a motor vehicle collision who had liver lacerations with subsequent development of hepatic artery pseudoaneurysms. In this case, embolization was not performed, and the pseudoaneurysms regressed spontaneously. Spontaneous regression has been reported previously, but its true prevalence is unknown. Our report includes full sonographic and partial computed tomographic (CT) documentation of the lesions during the course of their regression. To the best of our knowledge, this is the first report in the English literature with sonographic depiction of spontaneous thrombosis of a hepatic posttraumatic pseudoaneurysm in a child.

Twinkling Artifact in Gallbladder Adenomyomatosis

Gallbladder adenomyomatosis (GADM) is a common acquired benign hyperplastic disease of the gallbladder mucosa with prevalence of 2.8% to 5%. 1 Sonographically it is characterized by diffuse or focal thickening of the gallbladder wall associated with small intramural cystic spaces, known as Rokitansky-Aschoff sinuses. These sinuses may contain tiny echogenic foci that commonly cause a reverberation artifact. We describe and discuss a case of GADM that on color Doppler sonography showed a twinkling artifact. To the best of our knowledge, this finding has not been described previously.

Sonographically Guided Percutaneous Needle Biopsy of Soft Tissue Masses With Histopathologic Correlation

Objective. The purpose of this study was to evaluate the accuracy of sonographically guided percutaneous core biopsy of soft tissue masses. Methods. We retrospectively reviewed the medical records of patients who underwent sonographically guided biopsy of soft tissue masses at our institution during a 50‐month period. Core biopsy histopathologic results were compared with surgical or clinical follow‐up. Results. One hundred eighty‐three patients, 76 male and 107 female, with a mean age of 48.5 years were included in the study. Thirteen patients had more than 1 biopsy, and the total number of biopsies performed was 196. Five patients were lost to follow‐up. Biopsy results were diagnostically accurate in 174 (91%) cases. Thirteen biopsies were inconclusive. No complications occurred. The overall sensitivity, specificity, positive predictive value, and accuracy in separating malignant from benign lesions were 97%, 99%, 99%, and 98%, respectively. Conclusions. Sonographically guided core needle biopsy is an accurate and safe means to obtain tissue samples for the histopathologic diagnosis of soft tissue masses. It obviates the need for open biopsy and should be performed routinely for treatment planning.

Clinically unsuspected foreign bodies: the importance of sonography.

Objective. To show the value of sonography in the detection of clinically unsuspected foreign bodies appearing as soft tissue masses. Methods. High‐resolution B‐mode and color Doppler sonography was performed in 288 patients referred with superficial soft tissue masses over a period of 2 years. Results. In 8 lesions in 6 patients, sonography showed small curved or linear echogenic structures surrounded by hypoechoic masses characteristic of foreign bodies with granulation tissue. One lesion had increased vascularity on color Doppler sonography. Patients were referred for other imaging studies, including magnetic resonance imaging, computed tomography, and bone and labeled red blood cell scintigraphy, which did not add relevant information. Three patients underwent surgery; foreign bodies were found in 2, and infected granulation tissue was found in 1. Spontaneous resolutions and no growth of the lesions were seen in the other 2 patients. Conclusions. The possibility of a foreign body should be considered when scanning soft tissue masses even in the absence of a relevant clinical history. Once a foreign body is diagnosed, no further workup is indicated.

Sonographic Evaluation of Vascular Injuries

The purpose of this presentation is to highlight the color Doppler duplex sonographic features of procedure‐related and blunt or penetrating trauma‐related vascular injuries.

Appendicitis Within a Femoral Hernia Sonographic Appearance

Appendix within a femoral hernia was first described by the Parisian surgeon Rene Jacques Croissant de Garengeot in 1731 and is a rare, often incidental finding at surgery. Appendicitis in a femoral hernia is even more rare, and although it has been well reviewed in the medical literature, its sonographic appearance has been described only once. We report the sonographic findings of appendicitis in a femoral hernia and stress the potential benefits of this imaging modality in cases of acute groin pain and swelling.

Neonatal transient renal failure with renal medullary hyperechogenicity: clinical and laboratory features.

Sonographic findings of renal medullary hyperechogenicity have been observed in the neonate in association with severe perinatal renal injury, kidney malformations or nephrocalcinosis, and, rarely, in newborn infants with transient renal failure. The aim of the study was to describe the entity of neonatal transient renal failure with renal medullary hyperechogenicity (NTRFMH). We studied nine term neonates, born between August 1999 and February 2004 in our institution (0.1% of the live born infants), who developed transient renal dysfunction after birth, and in whom renal sonograms showed bilateral medullary hyperechogenicity. Seven of the infants (78%) had anuria until 30–45 hours of age, and two (22%) had oliguria. Peak serum creatinine levels ranged between 0.61 and 1.62xa0mg/dL (mean: 1.09±0.27xa0mg/dL) at 2–3 days of life. Additional findings included proteinuria in nine infants (100%), uric acid crystalluria in seven (78%), hyperuricemia in four (44%), and hypertension in one (11%). Hyperuricosuria was demonstrated in one out of the seven patients in whom this parameter was determined. Urinary excretion rates of calcium, phosphorus and oxalic acid were normal, as were urinary levels of amino acids and organic acids. Full clinical recovery accompanied by normalization of all laboratory parameters was observed in all infants by 4–6xa0days of life. Subsequent follow-up showed normal renal function, no urinary abnormalities, and normal renal sonograms in all infants. Our summary of the nine infants with NTRFMH reported on here and a review of 19 cases of this condition reported in the literature reveal a not-so-rare entity of unclear etiology, but excellent prognosis. Physicians caring for neonates should be aware of this benign and transient condition.

Prune belly syndrome: expanding the phenotype.

Departments of Neonatology, Diagnostic Imaging and Obstetrics and Gynecology, Meyer Children’s Hospital, Rambam Health Care Campus, and the Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel Correspondence to Dr Imad R. Makhoul, MD, PhD, Department of Neonatology, Rambam Medical Center, Bat-Galim, Haifa 31096, Israel Tel: + 972 4 8542219; fax: + 972 4 8543430; e-mail: makhoul@rambam.health.gov.il

Coping With War Mass Casualties in a Hospital Under Fire: The Radiology Experience

OBJECTIVEnWe report the role of the imaging department at a level 1 trauma center during the Second Lebanon War (summer 2006). Our institution received 849 military and civilian casualties, an average of 25 war-injured patients per day, 338 with acute traumatic stress disorders and 511 physically injured, coming in waves after a rocket attack or a battle confrontation. About 12 potentially critical physically injured patients per day were referred to the imaging department for sometimes complex imaging procedures. The unpredictable waves of casualties and nature of the injuries forced us to reorganize our routine workflow to provide adequate care to casualties and to nonemergent patients. Our nurses station was transformed into a small emergency department. The radiology staff was distributed into 12 diagnostic stations, providing 24-hour service. Communication was improved by means of walkie-talkies. Three ultrasound units were placed at the emergency department for immediate focused assessment with sonography for trauma performance enabling initial triage of patients. The site and extent of injuries were accurately diagnosed on CT and CT angiography. Digital angiography allowed definitive vascular diagnosis and interventional procedures.nnnCONCLUSIONnAdequate communication, strict workflow, and correct use of imaging protocols ensured optimal triage, diagnosis, and therapy of casualties while maintaining care for nonwar patients.